Burnout

“The interest of this project is assessing the prevalence of BOS (Burnout Syndrome) among physiotherapists who work in the Estremadura region (Spain)”

I can already hear the arguments from other PT’s, “Why are you reading research from Spain?” and the answer is because we don’t have enough research from America. We will have to try to extrapolate some of the information from this article to see if it applies to our work environment. In the end, people are people and no one article will apply to everyone, but maybe some bits of knowledge can come out of this article to help many.

Let’s start with burnout. It exists in healthcare and this sector has one of the highest rates of burnout among sectors (think like education, healthcare, transportation, law enforcement etc).

From the other research articles that I am reading, burnout is characterized by emotional exhaustion, depersonalization, and low professional (sense of) accomplishment.

“LPA (low professional accomplishment) is clearly higher in the case of split shift working day as well as in private practice”

A split shift, in this study is defined as just that, a shift that is non-consecutive. For instance, there was one job that I was interested in that would take a two-hour lunch in order for the people working there to go to the gym next door. As much as I was in favor of it, it would have meant another hour away from my family…so I politely turned it down.

Private practice is private practice. We have this here in the states. Private practice is traditionally seen as a capitalistic venture, in which the owners are trying to make as much money as possible.

“…more than 40 hours of direct attention (patient contact) is linked to higher scores in EE (emotional exhaustion), and that more than 20 patients treated per day is associated with higher scored in both EE and Dp (depersonalization)”

Are you surprised?

We treat sick people day in and day out. We treat people in pain day in and day out. We are constantly taking the burden of others in trying to help these folks. It can be exhausting. The other option that could happen when a person becomes emotionally exhausted is to just “shut it down” and then depersonalize work and simply “go through the motions.”

Is this what you want in a health care provider?

Be on the lookout when you go to therapy to see if the therapist is seeing one patient at a time or more than one patient at a time because it can start to give you insight into the PT’s mindset.

“Physiotherapists included in our study had a moderate level of BOS (burnout syndrome) in its three dimensions: EE (emotional exhaustion), Dp (depersonalization) and LPA (low professional accomplishment).”

Although I don’t believe that I fit into this category, it is becoming more obvious from talking to other PT’s in the profession that this is a major problem that will have to be addressed in the not-so-distant future. Think about it! The population is becoming older, we have a shortage of PT’s and there will be a higher demand for our services. There are only so many of us to go around and if the PT works for a company that values $$$ over quality, then the PT’s will be asked to see more and more patients per day. This appears to be leading the charge for burnout, based on the conversations that I have with other PT’s.

I did an informal survey on FB to determine the primary cause of burnout among the professionals and the primary answer was productivity demands. For those of you that aren’t in healthcare, this means how many patients are you billing per hour. WE DON’T MAKE WIDGETS!!!! We can’t treat people like WIDGETS! It makes sense that some PT’s are getting their ethical buttons pushed and start to depersonalize. One PT that I spoke to literally said that he was exhausted from TREATING PATIENTS!

Are you kidding me?!

It’s only getting worse out there. As a patient you need to know what’s happening in the profession and choose a PT that is giving you undivided attention when you are in the clinic (THAT’S WHAT YOU ARE PAYING FOR!) and as a PT, you have a choice to work in a place that is asking more from you than you can deliver or you can leave and find something different.

“…the age of physiotherapists does not seem to have any influence in the syndrome. However, there is an adjustment period, at the beginning of the physiotherapist’s professional development, where they are especially vulnerable to the development of BOS (burnout syndrome).”

Old and young alike feel stress. We all have ethical buttons. Some that have swam the waters of this profession for years have learned to live with it, but those coming out are facing challenges that are considered taboo to speak of in school. It’s only due to social media that these topics are becoming more mainstream for students to learn about.

“…physiotherapists who work split shifts and more than 38.5 hours per week are those who present the highest level of BOS (burnout).”

I don’t know any PT’s, minus those that don’t choose to work full-time, that are consistently putting in less than 39 hours per week. I am personally putting in a ton of hours per week of direct patient care and indirect care through notes, blogging and doing videos.

“Burnout syndrome reaches its highest levels in those who dedicate more than 40 hours per week of direct attention to patients…”

Should we even bring up student loan debt?

If you want a comfortable/stable life, then you will work more than 40 hours per week. Otherwise, you will pay your student loans off over decades. That ball and chain will always be there. Click here to learn more about the ball and chain.

I personally receive income from three different companies, which I wished that I did sooner instead of waiting almost 10 years to work multiple jobs. On the flip side though, had I done this sooner, then I may have experienced burnout and not be in the position that I am in today.

“…more than 20 patients per day have the highest levels of EE (emotional exhaustion), Dp (depersonalization) and BOS (burnout)”

PTs: Does this fit the description of the person and therapist that you want to be? If so, go forth and treat 2+ patients per hour. Just know that you are making that decision and there is no sympathy for you in the end.

Patients: Does this describe the person that you want treating you? Emotionally exhausted, depersonalized and burnt out? If not, look around. How many patients are there per therapists.

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Published by Dr. Vince Gutierrez, PT, cert. MDT

After having dedicated 8 years to growing my knowledge regarding the profession of physical therapy, it seems only fitting that I join the social media world in order to spread a little of the knowledge that I have gained over the years. This by no means is meant to act in place of a one-one medical consultation, but only to supplement your baseline knowledge in which to choose a practitioner for your problem. Having completed a Master of Physical Therapy degree, the MDT (Mechanical Diagnosis and Therapy) certification and currently finishing a post-graduate doctorate degree, I have spent the previous 12 years in some sort of post-baccalalaureate study. Hopefully the reader finds the information insightful and uses the information in order to make more informed healthcare decisions.
MISSION STATEMENT:
My personal mission statement is as follows: As a professional, I will provide a thorough assessment of your clinical presentation and symptoms in order to determine both the provocative and relieving positions and movements. The assessment process and ensuing treatment will be based on current and relevant evidence. Furthermore, I will educate the patients regarding their symptoms and their likelihood of improving with either skilled therapy, an independent exercise program, spontaneous recovery or if the patient should be referred to a separate specialist to possibly provide a more rapid resolution of symptoms. Respecting the patient’s limited resources is important and I will provide an accurate overview of the prognosis within 7 visits, again based on current research. My goal is to empower the patient in order to take charge of both the symptomatic resolution and return to full function with as little dependence on the therapist as possible. Personally, I strive to be an example for family and friends. My goal is to demonstrate that success is not a byproduct of situations, but a series of choices and actions. I will mentor those, in any way possible, that are having difficulty with the choices and actions for success. I will continue to honor my family’s “blue-collar” roots by working to excel at my chosen career and life situations. I choose to be a leader of example, and not words, all the while reducing negativity in my life.
I began working towards the professional aspect of the mission statement while still in physical therapy school. By choosing an internship that emphasized patient care and empowering the patient, instead of the internship that was either closest to home or where I knew that I would have the easiest road to graduation, I took the first step towards learning how to utilize the evidence to teach patients how to reduce their symptoms. I continued this process by completing Mechanical Diagnosis and Therapy courses A-D and passing the credentialing exam. I will continue to pursue my clinical education through CEU’s on MDT and my goal is to obtain the status of Diplomat of MDT. Returning back to school for the t-DPT was a major decision for me, as resources (i.e. time and money) are limited. My choice was between saving money for the Dip MDT course (about 15,000 dollars) and continuing on with the Fellowship of American Academy of Orthopedic Manual Physical Therapists (FAAOMPT) (about 5,000 dollars), as these courses are paired through the MDT curriculum or returning to school to work towards a Doctorate of Physical Therapy degree. I initially planned on saving for the Dip MDT and FAAOMPT, but life changes forced me to re-evaluate my situation. The decision then changed to return for the tDPT, as my employer paid for a portion of the DPT program. My goal for applying to and finishing the Dip MDT and FAAOMPT is 10 years. This is how long I anticipate that it will take to finish paying student loans and save for both programs, based on the current rate of payment.
I don’t know if I will ever accomplish what I set forth in the mission statement, but I do know that it will be a forever struggle to maintain this standard that I set for myself.
View all posts by Dr. Vince Gutierrez, PT, cert. MDT